| Arkansas Tech University | |
|
1306 N El Paso Ave Russellville AR 72801-8814 | |
| (972) 367-4845 | |
| Not Available |
| Full Name | Arkansas Tech University |
|---|---|
| Speciality | General Practice |
| Location | 1306 N El Paso Ave, Russellville, Arkansas |
| Authorized Official Name and Position | Mouzon Bass (ADMINISTRATOR/AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Arkansas Tech University 5050 Spring Valley Rd Dallas TX 75244-3995 Ph: () - | Arkansas Tech University 1306 N El Paso Ave Russellville AR 72801-8814 Ph: (972) 367-4845 |
| NPI Number | 1588136428 |
|---|---|
| Provider Enumeration Date | 12/17/2018 |
| Last Update Date | 12/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588136428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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